Transcription:
Treating Concussions in Children

Melanie Cole (Host): What are the signs of a concussion, and what should you do
if your child has suffered from one? My guest is Dr. Michael Jaffee. He’s a neurologist specializing in concussions and traumatic brain injury, and he was prior the National Director of Defense in Veteran Brain Injury Center. Welcome to the show, Dr. Jaffee. What is a concussion?

Dr. Michael Jaffee (Guest): Thanks. It’s great to be here. Concussion has been really getting a lot of attention lately. We used to think that concussions require a loss of consciousness following a blow to the head, but we know a lot more now, and we realize that a concussion can be caused by any attack to the head or any force that is transmitted to the brain. And what we see can not only be a loss of consciousness but what we call an alteration of consciousness, and that could be something as simple as seeing stars or feeling dazed and confused for a couple of minutes following such an impact. What we’re really looking at is on the outside of what’s happening on the inside, a transient surge or release of chemicals in the brain caused by that force.

Melanie: What are the most common concussion symptoms? I wonder this both for parents, for the coaches, and even for other athletes that might be, including the buddy system out on the field, that can keep an eye on each other. What is it we’re looking for?

Dr. Jaffee: That’s a great question. The way we think about that is we kind of divide the offenses to three different symptom types or symptom clusters. You can have physical symptoms, cognitive symptoms, or behavioral symptoms. Some of the most common physical symptoms include headaches, dizziness, sensitivity to light, and difficulty with your sleep. Some of the most cognitive symptoms include difficulties with attention or difficulty with short-term memory, and then some of the most common behavioral symptoms may include things like irritability or changes in mood. And people can have one or two of any of these symptoms or different combinations, and people present the symptoms of their concussion differently. But I would say that those are probably the most common types of symptoms that people are going to be causing people problems.

Melanie: Dr. Jaffee, with the equipment today, are we seeing a decrease in the incidence of concussion as we’re hearing more about them? But in sports such as football, they’ve got helmets on. Are these protective? Can parents rest a little easier, or no, not so much?

Dr. Jaffee: I think there’s a combination of things that’s happening, one of which is improvements in equipments, in helmets, and things like that. But I think the most important thing is the awareness that’s going on, and there’s a lot more recognition of this. There’s now more guidance for parents and coaches and teachers and doctors to provide appropriate management for when a concussion does occur to a child or anyone, and a lot of states now have requirements. There’s baseline testing done before season, in some of the organized sports and a whole protocol that’s being done, and we’re seeing that mirrored from the professional level to the NCAA down to the high school and other recreational sports levels, that increased awareness. And so we’re better able to recognize what’s happening and manage it, and by doing that, we’re really preventing long-term problems and really promoting quick recoveries.

Melanie: If you suspect that your child has a concussion, what are the treatments? How is it treated? Do we give Ibuprofen or Tylenol at home, keep a close watch? Do we keep them home from school?

Dr. Jaffee: Well, that’s a great question. First thing we want to do is protect the child from having any other concussions. So if they suffered a concussion in a sports event, we want to remove them from play at that point in time and not send them back to the game that same day. Give them a chance to recover. So what we’ve come up with is really a combination of refresh at least the full day, and then a form of active recovery. And that active recovery is going to be done in a graduated manner. At first, when we see that the symptoms are resolved at rest, we know that sometimes, if you start exerting yourself, that can bring about a headache or dizziness or some of the symptoms you were suffering from. And as part of the recovery process though, to keep that going and prevent recovery from plateauing we come up with an active program in that we sort of return them to activity gradually to see if they can tolerate that, and then we move them up. And we don't really get back to contact activities until they’ve gone through aerobics and other types of exertion showing that they’ve recovered from that. The other aspect you ask about is school, and there’s a similar approach to that, and that should be initially brief, like a day. But then it’s active. So rather than keep someone from school, we want to get someone the benefit of education if they can, start gradually exercising their brains, just as you was gradually exercise your body, and give them accommodations initially that they need a little bit of extra time to take a test or delayed taking exam. But we want them to not stay out of the classroom for too long and start figuring out ways to keep going, because we want to exercise that brain, and that helps promote recovery.

Melanie: When you say exercise the brain, what about things like video games and television? On the day right after a concussion, do you let your child sit there and play video games? Is there any risk to this?

Dr. Jaffee: I think that’s part of the brief rest component, where right away we would want to do things to reduce the stimuli. A couple of things is, especially with the light sensitivity that can happen with concussion and the multiple stimulation that happens with video games, it might be a little bit too much right initially. So I would say for the first day or so to not do that. And then with everything else, we would go with a graduated return, and that starts with watching videos or work on the computer, seeing how that goes, making sure that doesn’t produce a headache or dizziness, and if they can tolerate that for the day, then gradually on up until you get all the way back up to those full video games with all the stimulation that’s involved. So that’s part of the whole model of brief rest and active recovery.

Melanie: During active recovery, when do you know that your child can return to play? If they sustain this concussion during football or even soccer, any of these sports, when do you know they’re safe to return?

Dr. Jaffee: One of the things we do now is we look at a couple of things with that, one of which is if the symptoms that they were having resolved, have those gone away? And if we put them to physical activity, do they stay at bay. They haven’t come back because you’re running or increasing your heart rate. That’s just the one part of the self-report symptom aspect. And then with a healthcare professional who has some training in this, they can do an examination, make sure there’s no subtle signs of any residual injury or damage to the individual. In some cases, we may do some additional diagnostic assessments using some form of cognitive testing looking at how well you perform with your memory, making sure that that looks well and tested well and all those things together really combine to make an informed decision for returning to play and returning to activities.

Melanie: How is the UVA Brain Injury and Sports Concussion Clinic working to improve concussion care, doctor?

Dr. Jaffee: Well, there’s this really an exciting initiative we have at the University of Virginia because it’s truly multidisciplinary. What we’ve done is we brought together a number of different professionals together to provide individualized and tailored care for people who may be having problems in recovering from their concussion. So under one roof, we have adult neurology, child and adolescent neurology, physical therapy, occupational therapy, physical medicine rehabilitation, neuropsychology with ready access to other specialties such as pain management, neurosurgery, sports medicine. We actually have with us in the clinic experts in psychiatry and sleep medicine. And so for people who are having challenges where all of us together can evaluate the individual and come up with an individualized and coordinated plan of care. And the other exciting aspect of this is recovering all forms of injury, not just sports injury, and every severity of injuries—concussion on up through the moderate to severe injuries. So we really cover the entire spectrum and the entire patient population in a coordinated way, and we actually have members of our team who are helping with the inpatient care for those who have more severe injuries and helping to provide a system of care as they go through the medical system, as they are leaving the hospital making sure they have good tracking and appropriate follow-up. Our individuals are very much involved with outreach and education in the community, working with local school systems, making sure they’re up to date on the latest innovations in concussion care, and we’re very well ingrained with the UVA athletic department. And so it’s really exciting to have this synergy and cooperation with all of these people together.

Melanie: In just the last 30 seconds or so, Dr. Jaffee, give us your best advice regarding concussion prevention, your best advice for parents.

Dr. Jaffee: Kids want to do the sports they love, so our job is to try and make sure they find the safest way to do it, and that involves taking care of the appropriate practices, using the appropriate policies, appropriate equipment, and appropriate management. So I would just make sure to ask the school what their policy is. Most schools now are required to have one, and if they don’t, we can certainly link them to a professional to help with that education because our goal is to promote the activities that people love but to do it in a safe way.

Melanie: Thank you so much, Dr. Michael Jaffee. You’re listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening. Have a great day.